What to Expect After An Extraction, Side effects and Possible Complications

After your treatment has been completed and you have recovered from any sedation used Dr Murnane will discuss how the treatment went, he will also explain and discuss how you will feel over the coming days and how to care for your mouth. You will be given advice on pain and infection control. You will be provided with a prescription for painkillers and antibiotics to use in the coming days.

You will be asked to return home and rest for at least 3 hours and to avoid eating or drinking hot liquids.

Everyone hopes that their treatment and recovery will be uneventful. This unfortunately is not possible in the real world. Events will happen during and after treatment. Some are common and minor and others are rare but serious. Below you will find some information on possible side effects and complications.

Every wisdom tooth is different just like every patient is different, but the after effects of having your wisdom teeth removed will normally fall into one of three categoriesdepending on how much work has to be done to get the teeth out and the individuals responds to treatment.

Easy Extractions

It is possible to lever or elevate many teeth out. These patients will experience little or no bruising, pain or swelling and there are often no stitches. The extraction will take less than one minute. Most of these patients are back at work the next day. They will be on an antibiotic and using a mild painkiller occasionally and they will also be rinsing there mouth with warm salty water, but should be able to perform most routine daily tasks without any problems. Most wisdom teeth come out like this

Surgical Extractions (or Difficult Extractions)

The second group of patients will have had their teeth cut out. This takes about 7 minutes per tooth.This group of patients will be sore, bruised and swollen on there face for at least one week. They will need stronger painkillers and antibiotics and they will be rinsing their mouth frequently with salty water and Corsodyl mouth wash. These patients will normally need 4 or 5 days off work although some will need longer. Activity is only restricted by pain and sports should be avoided for about 2 weeks. About 30% of wisdom teeth come out like this.

Infection and Dry Socket

The third and thankfully a very small group about 5% are those who suffer complications such as dry socket and infection. Dry Socket is a severe pain after any dental extraction and lasts about 2 weeks. It is unpredictable and untreatable. Painkillers and antibiotics are in effective. You must simply keep your mouth clean with mouth washes and wait for the pain to resolve. You will be awake at night with pain and it is almost impossible to go to work.

Infection can occur after any dental extraction even if you follow all your instructions and take your antibiotics. It can be extremely painful and produce swelling both in your mouth and around your jaws. Infections will sometimes take 2 or 3 courses of antibiotics to clear and you will find it difficult to work for this period of time however most of the symptoms are controllable with painkillers, rest and fluids. As a rule of thumb when you feel able to return to work you are fit to return to work.

Some other complications include

BLEEDING

Your mouth will look red for an hour or two after wisdom teeth extraction or other extraction. This is normal, the blood clot is fragile and will dissolve, as the blood clot dissolves the water in your mouth turns red. this will produce red lips and teeth for several hours. It does not mean that you are bleeding.

It is normal to expect some slight oozing from an extraction socket or other wound. To minimize bleeding, keep activity to a minimum on the day of your surgery.

You should GO HOME and REST, SIT UP, AVOID LYING FLAT for at least 3 HOURS. Avoid eating or drinking hot liquids for at least 3 hours. Leave your mouth alone as much as possible for the remainder of the day.

After 3 to 4 hours you should be able to eat soft food gently and drink warm liquids. You should avoid the extraction sockets as food or hot liquid may make you bleed.

Should you experience bleeding, remember it will look worse than it is. All the water in your mouth will turn red and look like extra blood. Remain calm, if you become upset or anxious this will increase your blood pressure and make you bleed even more.

Sit up and rest, roll a clean tissue, cotton wool or gauze into a pad about the size of your finger, place it over the socket /wound and bite on it for twenty minutes AND REST. In the event of persistent bleeding do not hesitate to contact us.

It is very rare for bleeding to be persistent or dangerous. If bleeding is persistent it is often caused by a patients own anxiety over bleeding which raises your blood pressure and forces blood out. Also, repeated checking of the socket, pulling your cheeks back for inspection and removing and replacing of packing material all disturbs the blood clot and causes more bleeding.

Remember, every time you stop bleeding the clot which forms will need about 3 hours to gather strength so it will be easily disturbed and the area will bleed easily.

REST IS THE MOST IMPORTANT ELEMENT OF PREVENTING AND HALTING BLEEDING.

PAIN

Pain is to be expected after any dental extraction, especially wisdom teeth extraction, take whatever painkiller you would normally use if these are not strong enough use those prescribed for you. Please read instructions that accompany your painkillers and take your medication on a regular basis to increase its effect.

The degree of pain you can expect will vary with individuals and with the difficulty of the extraction. The more work which has to be done to extract your wisdom teeth, the greater the degree of post extraction pain. You will be given painkillers before your extraction and you will need more before bed that night. Pain will vary from mild to severe (in rare cases).

Dr Murnane will normally prescribe 75 mg of Difene to be taken twice a day and this will be sufficient for most individuals. If pain is severe then 2 tablets of Solpadol taken 4 times a day can be added to the twice daily Difene. This is a high dose of painkiller and will keep most pain (except Dry Socket pain ) under control.

WARNING Difene can hard on your stomach and some individuals are unable to take this medication

Solpadol contains Codeine and is addictive. Solpadol should be taken for as short a period as possible.

Dr Murnane will vary the medication prescribed to suit the individual and your prescription may vary from the above.

Painkillers will have a better effect if taken on a regular basis. An occasional painkiller will not produce good pain relief. If a particular painkiller does not agree with you stop taking it and use a different painkiller. If you are not sure what to take please contact Dr Murnane.

ANTIBIOTICS

You may be prescribed an antibiotic after wisdom teeth extraction. Some patients are asked to take the antibiotic and others will be advised they do not need an antibiotic but to keep a prescription available for an emergency. It is important that if you start a course of antibiotics that you you complete the course for the antibiotic to be effective. On rare occasions you may need several courses of antibiotics to clear up an infection.

It is often more important to use simple local measures to keep your mouth clean rather than rely on antibiotics to clear infection after wisdom / teeth extractions. The use ofWarm Salty Watergargled through and around the extraction socket after every meal for 7 to 10 days is very effective. Also rinsing the extraction socket with CORSODYL mouth wash before and after bed will help to reduce infection in a socket.

If you do not feel well taking the antibiotic you should contact this clinic or your Dr.

Please read the instructions that accompany any medication.

Please finish your course of antibiotics.

If your wisdom tooth is infected when it is removed you are more lightly to need an antibiotic. If there is no infection when the tooth is removed and you keep your mouth clean after the extraction then you are less lightly to need an antibiotic.

SWELLING

Some swelling of your face can be expected after any dental extraction especially after the the extraction of wisdom teeth, and depending on the difficulty of the extraction the swelling may be quite dramatic.In general The more difficult the procedure the more swelling you will have. Patients who bruise easily should experience more swelling. You may also have black eyes, black and blue dis-coloration around your face and down into your neck.

The swelling may increase in size for 48 hours after the extraction has been completed. Like any bruise it will take between 7 and 10 days to disappear. Swelling around your jaws may make it uncomfortable to eat and talk. You may need time away for work or college. If you feel the swelling is excessive or if you feel it is continues to worsen over several days please contact the clinic.

LOCAL ANAESTHETIC

You will be given dental injections before your extraction. The numbness that this will produce normally persists for about 3 to 4 hours.

Be careful that you do not bite your lip or cheek or scald yourself on hot liquids while you are numb. This will produce painful ulceration. The ulceration will resolve in 7 to 10 days but it is very unpleasant. If possible avoid eating and drinking hot liquids until the numb feeling has passed. You may drink cool liquids, smoothies etc.

Avoiding eating and drinking for several hours will also reduce the risk of bleeding after your extraction.

RINSING and CLEANING

Every time you eat some food will become deposited in your extraction socket. If food is left in the extraction socket it will rot and you will develop a painful infection. You must make every effort to keep your mouth as clean as possible after your extraction. If possible, do not rinse your mouth on the day of the extraction as this is likely to make you bleed.

For the following 7 to 10 days after you should rinse the extraction socket clean withWARM SALTY WATER to remove food from the socket after every meal (A tea spoon of table salt in a cup of warm water).

You should rinse the sockets withCORSODYL mouth wash morning and night for a week to 10 days.

Corsodyl will stain your teeth if used excessively. The staining will come off but you will need to have your dentist clean your teeth to achieve this. You should brush your remaining teeth gently, as usual, avoiding the socket area for a few days.

Brush the rest of your mouth as normal.

As soon as it is comfortable to do so you should gently brush the wound while brushing your teeth. This will keep the wound clean and will help stitches to dissolve. The socket usually takes 3-4 weeks to close over. It is unlikely that you will develop an infection after the first week but you will be picking food out for this time.

EATING

Avoid eating and hot liquid for about 3 to 4 hours or as long as your face is numb. A soft diet is advisable after this but eat what you can tolerate. Excessive chewing or hot liquids may make you bleed so eat soft food slowly and gently.

It is possible to bite your lips and cheek while you are numb. This will produce painful ulceration. This ulceration will heal within 10 days if kept clean.

In the days after your extraction eat whatever you can tolerate. If you are excessive it will become painful to eat and you will therefore naturally avoid tough food. If it feels comfortable to eat something it is generally ok to eat it.

Care must be taken to keep your mouth very clean after eating.

SMOKING

YOU MUST NOT SMOKE FOR AT LEAST 7 DAYS days after any extraction. Smoking delays all wound healing and increases the risk of infection. The more you smoke the more likely you are to develop an infection. If you do develop an infection after wisdom teeth extraction, it will be quiet painful and it will take a week or more to resolve.

ALCOHOL

You should not drink alcohol on the day of your extraction or for as long as you are taking painkillers or an antibiotic. Alcohol can have unpredictable reactions if taken with painkillers and antibiotics.

Do not drink alcohol if you have received sedation.

Alcohol is best avoided on the day of surgery as it will encourage bleeding.

DRY SOCKET

A Dry Socket is a very painful complication of any dental extraction. In its most extreme form it will be one of the worst pains many people will experience in the course of their life. It can be extremely distressing and will prevent you from working or engaging in any normal day to day activity. It will be the focus of your world for the 10 to 14 days you are suffering.

A dry socket is a recognised complication following any dental extraction including the extraction of wisdom teeth. In occurs after approximately 4% of all dental extractions.

A dry socket is more common after having wisdom teeth extraction on the lower jaw, after difficult extractions, in females and in patients taking the oral contraceptive.

The cause is unknown. The symptoms vary from mild to intense pain which may come on immediately after the dental extraction or approximately 3 days later and last between 10 and 14 days. On rare occasions the symptoms may last much longer. Once the pain of a dry socket passes the extraction socket will heal normally without further complication.

The pain is poorly or not relieved by painkillers, is constant and may keep you awake at night. Antibiotics will make no difference. Painkillers are generally ineffective. There is no effective treatment which a dentist can offer. It is best not to disturb the socket in the search for a cure as this can aggravate the condition.

Some dentist will place dressings in the socket in the hope of relieving the pain. This is effective in a minority of patients but also delays healing and may prolong the length of time with which you will suffer pain.

The only effective treatment is to keep the wound as clean as possible with either warm salty mouth washes and or Corsodyl mouth wash, Place CLOVE OIL or CLOVE OIL GEL in the socket (available from your pharmacist) this will ease the pain until the condition passes. The condition will then resolve naturally with no long term consequences.

NUMBNESS or ALTERED SENSATION to your LIPS, CHEEKS, CHIN or TONGUE

For most people this is a very unexpected complication of any extraction. There are many nerves in and around your mouth and jaws. A numb feeling in your lip, chin, cheek or tongue is a recognised but unpredictable risk of the removal of wisdom teeth and general surgery in your lower jaw.

One patient in every two hundred patients who has a lower wisdom tooth removed will experience some altered sensation or numb feeling after the removal of wisdom teeth.

This is usually short lived and full feeling will usually return in 3 to 6 months. It can on rare occasions take up to 18 months to recover and it is possible, but quiet rare for the numb feeling to last for ever. There is no effective treatment.

The risk of numbness is greatest in the lower jaw, especially with wisdom teeth extraction. However any time a surgical procedure is carried out in your mouth there is a risk of altered sensation. The risk is usually unpredictable and is un-treatable.

Please read the section on wisdom teeth extractions for a more detailed discussion.

ULCERATION

Ulceration of the skin of your mouth may happen after any wisdom tooth extraction or dental procedure. There are several possible causes.

Biting or chewing your self while numb

Scalding your self with hot liquids

Surgical trauma

Stress induced ulceration

Oral ulceration can be quiet painful, however the ulceration will heal uneventfully within 7 to 10 days. The use of a mouth wash” Difflam ” will help to numb the ulcerated area and make eating comfortable until the ulcers heal.

Fracture of Associated Teeth

Teeth with large fillings or teeth which have started to rot are weak. The extraction of any tooth, especially a wisdom tooth requires that a certain amount of pressure be applied to the area of the dental extraction. Some pressure will always pass to associated teeth. This can result in teeth in the area of an extraction absorbing some pressure and flexing. If teeth are already weakened by dental decay or large fillings the teeth may fracture or the fillings may fall out. This is an unfortunate and relatively common complication of the extraction of teeth. If possible you will be warned beforehand of this possibility if a tooth is obviously weak but any tooth can break and only after the break will the dental decay be discovered. The cost of fixing these broken teeth must fall on the owner of these broken teeth.

LOOSE TEETH

Teeth on either side of an extraction socket may feel a little loose after a dental extraction. This is very common and it is due to a combination of factors

Pressure applied during the extraction.

Lack of support for the remaining teeth

Disease which has destroyed the bone holding in the teeth

The force applied during an extraction will be absorbed by surrounding teeth to some degree and this can make the surrounding teeth a little loose.

When a teeth is extracted there will be a hole in the bone and the surrounding teeth may simply have less support to hold them steady.

The degree of mobility of these loose teeth is usually minor and if the teeth are simply avoided for a week or so they will firm up again.

If a disease process has destroyed the bone then they may never firm up and may eventually require extraction also.

ORAL ANTRAL FISTULA

An Oral Antral Fistula is a hole created in the roof of your mouthduring a dental extraction. The hole allows food and liquid to pass up into your cheek bone, which is hollow. This is a common occurance. This hole if small will close by itself. If The oro antral fistula is large it must be closed surgically. This results in a considerable degree of bruising and swelling for about one week. Please see the article on Oro antral fistulas for a more detailed discussion on this topic.

Teeth or Roots displaced into your Sinus

When an oro antral fistula is created during a dental extraction it is possible that the tooth or a portion of the tooth is displaced into the hollow cavity of your cheek bone (maxillary sinus). This can predispose you to sinus infections and will often need to be removed. Please see the article on this topic for more information.

Swallowing or Inhaling Fragments of Teeth

During a dental extraction teeth will often break into multiple fragments, fillings will break and fall out etc. All these fragments need to be removed from your mouth. Occasionally a patient will swallow a fragment. This will pass harmlessly through your system and emerge at the other end.

It is also possible ti inhale a portion of a tooth into your lungs. This is a more serious event. If there is any doubt as to the position of a tooth a chest x ray must be taken to confirm the tooth is not in one of your lungs.

Any tooth portion found to be in your lung must be removed. This will involve a hospital referral.

A Broken Jaw

A fracture of your jaw bone during a dental extraction is a rare event but will occasionally happen. It is unpredictable, however there will usually be a specific factor which has predisposed somebody to breaking their jaw. If the fracture is incomplete and undisplaced then a soft diet and painkillers may be all that is required. A complete and displaced fracture will require referral to a maxillo-facial surgical unit to have the fracture repaired.

Persistent Pain after an Extraction

Pain which persists after a dental extraction or any othe oral surgical procedure is a very rare complication of an extraction. The cause is unknown. There is no effective treatment and each case must be treated individually. A pain of this type will usually not respond to anti-biotics, regular painkillers or further surgery.

A referral to a pain specialist is often the only option open to the sufferer.

SEDATION

Sedation is a method of reducing the level of consciousness. It produces a light sleeping (twilight) state. It is safer than general anaesthetic. It wears off quicker and with fewer side effects than general anaesthetic.

It is administered through a drip in your arm. You will initially feel very relaxed as if you have drunk some alcohol and then most people drift into a light sleep. The vast majority of people will have absolutely no memory of the wisdom teeth extraction or other treatment.

Some patients will remember their treatment even though sedated. This is normal. Everyone responds differently to sedation. The memory is usually vague, dissociated, incomplete and not at all distressing.

Occasionally a patient may cry out while sedated. Again this is normal as everyone responds differently to sedation

Sedation is not designed or intended to produce an unconscious (fully asleep) state. It is intended to relax you sufficiently to allow you to have your treatment.

As thes sedation wears off you will feel as if you have been drinking alcohol. You will be light headed and your legs will be very heavy. Sedation normally takes about one hour to wear off; however the length of time will vary with individuals. Once you can walk and talk in a coherent manner, there is a responsible adult present to bring you home and care for you and Dr Murnane has assessed you, you will be allowed home.

You should rest in bed for at least 3 hours after you get home. After this you may resume light activity around your home. However do NOT attempt to Drive, use Machinery or drink Alcohol for the remainder of the day. Keep activity to a minimum and rest as much as possible. You should stay in adult company for the remainder of the day to prevent you doing something foolish. There are no restrictions on activity for the following day.